Eczema Explained

What is eczema?

Eczema is dry, itchy inflamed skin.

There are several types of eczema, depending on the clinical appearance, the age of the patient and the cause. The types of eczema are:

Atopic eczema – commonest in infancy and childhood, often in children with a family history of asthma, eczema and hayfever (atopy).
Non-atopic eczema – for those children who do not have a history of hayfever and allergy.
Discoid eczema – coin-shaped patches of eczema usually on the limbs.
Varicose eczema – dry, itchy inflamed skin of the lower legs, usually in the older age groups and associated with varicose veins and leg swelling.
Contact dermatitis – an eczema caused by contact with an external agent in the environment to which the patient is allergic, eg a metal, such as nickel.
Irritant dermatitis – an eczema caused by an external agent (or several) which effectively irritate the skin and/or dry it out.

Often the picture is not so clear-cut and several factors may be at play to trigger eczema in you.

Is eczema due to an allergy?

Eczema is not caused by allergy, but in some children with severe eczema or eczema which does not respond to first-line treatment, food allergies may be a contributory factor.

A history of an immediate reaction to a food or a consistent reaction to a food is a useful indicator, especially if this is combined with other factors such as tummy pain, vomiting, constipation or diarrhoea, lip and facial swelling and failure to thrive (not gaining weight satisfactorily or not keeping to the weight and height centiles in the Red Book). Allergy tests may be considered in these cases, but your consultant dermatologist will discuss this with you.

Contact dermatitis is caused by an allergy to one of various external agents and can be of relevance in some cases of hand or face dermatitis or in certain occupations, eg hairdressers, florists, chefs. Patch testing may be considered in these cases.

What are the treatments for eczema?

The problem with eczema is mainly that the skin is dry and inflamed. No one treatment will cure eczema, but simple regimes can treat eczema effectively.

Emollients:

In the bath, eg oils and daily bathing to keep the skin clean
As a soap substitute to clean the skin, yet keep the moisture locked in
As a moisturizer applied liberally all over at least twice a day, ideally more if possible.
Your dermatologist will advise you of the different types of emollients available.

Topical steroids:

These are the current first-line treatment for eczema (NICE guidelines 2007)
Your dermatologist will advise you how best to apply these.
It is better to use a topical steroid of sufficient strength to control the eczema rapidly, followed by intermittent use to keep the eczema at bay, than to use a weak steroid long term, with poorly controlled eczema as a result.
Many people worry about the risk of your skin thinning where the steroid is applied repeatedly. This risk is highest with the most potent topical steroids, which are not routinely used for the treatment of eczema in children. Skin thinning should not occur if you are under appropriate supervision.

Topical calcineurin inhibitors eg tacrolimus (ProtopicÒ) and pimecrolimus (ElidelÒ):

These are second-line agents in the treatment of eczema, for those who have not responded well to the stronger topical steroids, or for those for whom the side effects of topical steroids have become a problem.
They have been shown to be effective forms of treatment for eczema, especially in areas where the skin is more delicate, such as the face.
They do have potential risks and concerns and Protopic is available in different strengths, which are licensed for different ages.
There are different regimes for applying a topical calcineurin inhibitor, which your consultant dermatologist will explain to you, if treatment with these products is being considered.

Antihistamines

Non-sedative antihistamines can be helpful to control itching during the day.
Sedative antihistamines can be helpful with night-time itch, to help you have a restful night’s sleep.

Other treatments:

Dry wraps/wet wraps – a specialist dermatology nurse will teach you how to apply these.
Exclusion diets – only relevant to children, after a proven food allergy and only under supervision of a paediatric dietician/allergy doctor, as essential vitamins and nutrients may be missing from the diet, if it is undertaken unsupervised.
Oral steroids/azathioprine/ciclosporin – for very severe, resistant cases of eczema. These should only be prescribed by a consultant dermatologist or paediatrician.

For the other forms of eczema, eg varicose eczema, there are additional treatments which may be helpful, for example compression bandaging. Your consultant dermatologist can explain these further.

Will I always have eczema?

Allergy type eczema tends to improve as children get older, with the majority growing out of it by the time they start full-time school. A few of these children may have occasional relapses as they grow into teenagers. Only a few continue to have persistent disease into adulthood.

The other forms of eczema, ie contact dermatitis, will improve if the trigger cause can be identified and avoided.